Patients with normal renal function, COVID-19 may not be at risk for specific AKI
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Patients with normal renal function who have tested positive for COVID-19 and are undergoing chest CT angiography may not have an increased risk for contrast-associated AKI.
Further, investigators noted that CT angiography should be performed on this population if physicians have concern for a pulmonary embolism (PE).
“Patients with COVID-19 are at increased risk of both PE and renal injury. This represents a clinical challenge, as the gold standard examination for PE uses iodinated contrast, which has been associated with renal injury, particularly in patients with underlying kidney disease,” Farzad Sedaghat, MD, assistant professor of radiology and radiological sciences from Johns Hopkins School of Medicine, told Healio. “Our investigation evaluated whether symptomatic renal-competent COVID-19–positive patients are at increased risk for developing contrast-associated acute kidney injury (CA-AKI).”
In a retrospective study, researchers examined data for 587 patients with COVID-19 who underwent non-contrast CT and CT angiography (CTA) at an apex tertiary medical center between March 1 and Dec. 10, 2020. Researchers identified 258 renal-competent patients (defined as patients with an eGFR >30 mL/min/1.73 m²) with baseline and 48- to 72-hour post-examination creatinine measurements and analyzed them for the incidence of AKI that met criteria for CA-AKI. All patients tested positive for COVID-19 at least 14 days prior to CT imaging.
Following the completion of initial summary statistics, researchers conducted testing to compare the demographics and clinical characteristics between the CT and CTA cohorts. Using univariable and multivariable logistic regressions, researchers measured the relationship between contrast administration and AKI that met CA-AKI criteria.
A total of 67 patients who underwent non-contrast CT and 191 patients who underwent CTA were included in the final analysis. Among the non-contrast CT cohort, 13.4% experienced creatinine increases that met criteria for CA-AKI compared with 13.1% of the CTA cohort. Analyses revealed no association between iodinated contrast administration and the incidence of AKI that met criteria for CA-AKI.
“Our evidence suggests CT angiography is safe in COVID-19 patients with normal renal function and should be performed if there is clinical concern for PE,” Sedaghat told Healio. “Our research informs our current clinical practice, where we continue follow American College of Radiology/National Kidney Foundation consensus guidelines for contrast administration. We are currently monitoring new COVID strains, which may have different virulence and biologic behavior. Additionally, further investigation is needed to evaluate the safety of contrast administration in patients with marginal renal function.”
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